Urinary incontinence Flashcards
What is urinary incontinence?
Involuntary leakage of urine
Urinary incontinence is common. T/F
True
Which sex experiences urinary incontinence more commonly?
Female
List the types of urinary incontinence
Overflow
Urge
Stress
Mixed
By which two means might urine leak extra-urethrally?
Extopic ureter
Fistula
Explain the normal micturition cycle
Storage phase - intravesical pressure lower than intraurethral pressure so urine stays in bladder
Voiding phase - detrusor contracts increasing intravesical pressure above intraurethral pressure causing relaxation of sphincters and micturition
What affects intravesical pressure?
Urine volume
Detrusor muscle
Abdominal pressure (coughing, sneezing, etc)
What is urodynamics?
An invasive test measuring pressure within the bladder and abdominal cavity and detrusor muscle pressure
How is a urodynamic test carried out?
Pressure sensor in bladder
Pressure sensor in rectum
Ask patient to cough three times - each time with more force
What are the components of the micturition reflex?
Bladder
Sphincters
Brain
Spinal bladder centre (S2-3)
Which nerves are involved in the micturition reflex?
Pelvic parasympathetics (bladder & internal sphincter) Pudendal (external sphincter)
The micturition reflex is inhibited and facilitated by descending controls from the brain. T/F
True
What causes overflow incontinence?
Outflow obstruction
How does overflow incontinence present?
Huge palpable bladder
Chronic retention
Enuresis
Insensible incontinence (only aware after feeling wetness)
Renal impairment (due to back pressure of urine)
What causes urge incontinence?
Detrusor overactivity
How does urge syndrome present?
Increased frequency Small volumes of urine Urgency (provoked by sounds, standing, coughing, laughing, sneezing) Enuresis Urge incontinence
What is detrusor overactivity?
Contraction of detrusor during inhibition of micturition
How is detrusor overactivity diagnosed?
Urodynamics
What causes detrusor overactivity?
Afferent overstimulation (stone, tumour)
Excess central facilitation (anxiety)
Paraplegia (loss of central inhibition)
Destruction of bladder centre (S2-3) - inert bag bladder
Pelvic surgery/fracture –> parasympathetic nerve damage
Idiopathic
What is damage to parasympathetic nerves associated with?
Higher risk of infection
What nerve is not affected when parasympathetic nerves are damaged?
Pudendal!
How does idiopathic detrusor overactivity usually present?
Older woman
Urgency
Frequency
Urge incontinence
What is (urodynamic) stress incontinence?
Leakage of urine during increased intra abdominal pressure WITHOUT detrusor contraction
What causes stress incontinence?
Damage to pelvic floor
Damage to urethral function
i.e child birth
How is stress incontinence diagnosed?
Urodynamics
When might frequency occur with stress incontinence? Which symptom should not be present?
As a learned behaviour to try and prevent/reduce incontinence
Urgency
How should the bladder feel on examination (if it is full)?
Painless mass arising from pelvis
Cannot “get below it”
Dull to percussion
Nb - in female patients it could be pregnancy
How is overflow urinary incontinence treated?
Assessment of renal function
Catheterisation to treat obstruction
Rehabilitation of bladder (teach how to self catheterise)
How is urge urinary incontinence treated?
Avoid caffeine Bladder retraining Timing of bladder emptying Pharmacotherapy Neuromodulin (pacemaker) Enterocystoplasty
Which pharmacological options are available in the treatment of urge incontinence? What are the side effects?
Anti-muscarinics e.g oxybutinin, tolterodine (dry mouth)
Beta 3 adrenergic i.e mirabegron
How is stress incontinence treated?
Weight loss Smoking cessation Physiotherapy (pelvic floor exercises) Pharmacotherapy (not useful) Surgery (open vs tape)
How is mixed incontinence treated?
Combination urge and stress treatment approach
What are risk factors for urinary incontinence in the elderly?
Dementia Immobility Drugs (diuretics, sedatives) Obstruction --> overflow Neuropathy Weak pelvic floor
Ectopic ureters are congenital. T/F
True
What is the cause of most vesico-vaginal fistula?
Prolonged obstructed labour
What is urgency?
Sudden, compelling desire to pass urine
List some voiding symptoms
Slow stream
Abnormal stream (splitting)
Hesitancy
Straining
What is a frequency volume chart?
Used to measure urine output (& at which time of day) for at least 24 hours
